Cardio Problems Common in Cocaine-Related Sudden Deaths

In southwest Spain, 3.1% of sudden deaths are related to cocaine use, an autopsy study found.

Action Points

Explain to interested patients that this Spanish study found that the majority of sudden deaths related to cocaine use had underlying cardiac causes.

Explain to interested patients that no amount of recreational cocaine use is safe since even small amounts may have catastrophic consequences, including sudden death.

In southwest Spain, 3.1% of sudden deaths are related to cocaine use, an autopsy study found, indicating that recreational use of the drug is fraught with peril.

Most of the cocaine-related deaths had cardiovascular or cerebrovascular causes, Joaquin Lucena, MD, PhD, of the Institute of Legal Medicine in Seville, Spain, and colleagues reported online in the European Heart Journal.

Left ventricular hypertrophy, small vessel disease, and coronary atherosclerosis were common findings, which "may account for myocardial ischemia and cardiac arrest associated with the use of cocaine," they wrote.

In an accompanying editorial, Richard Lange, MD, and L. David Hillis, MD, both of the University of Texas Health Science Center in San Antonio, added that "the notion that recreational cocaine use is 'safe' should be dispelled, since even small amounts may have catastrophic consequences, including sudden death."

Because cocaine use is a growing problem, they wrote, "it is important to implement procedures with which drug use can be monitored and reported systematically and consistently."

This includes "the use of uniform protocols when performing postmortem examinations in victims of sudden death to include toxicological examination of the blood and urine for illicit drugs."

Until this occurs, they said, the use of cocaine and illegal drugs and their associated complications will be under-recognized.

Of all illegal drugs, cocaine is responsible for the highest number of emergency department visits in the U.S. and Europe.

The rate of lifetime cocaine use in Spain is 7%, the second highest in Europe behind the U.K. (7.7%). Both are about half the lifetime cocaine use rate in the U.S., according to Lange and Hillis.

To examine the characteristics of cocaine-related sudden deaths, Lucena and his colleagues examined all autopsies performed over a 32-month period in the province of Seville in southwest Spain, which has a population of about 1.9 million.

Of 2,477 autopsies performed, 668 met criteria for sudden death. Of those, 21 (3.1%) were deemed to be related to cocaine use. All were males ranging in age from 21 to 45 (mean age 34.6).

Cocaine was detected in 67.1% of blood samples and 83% of urine samples, with a wide range of concentrations.

"Any amount of the drug can be considered to have the potential for toxicity due to the fact that some patients have poor outcomes with relatively low blood concentrations, whereas others tolerate large quantities without consequences," Lucena and his colleagues wrote.

"In fact," the editorialists Lange and Hillis noted, "cocaine-related myocardial infarction has been reported following the ﬁrst-time administration of as little as 0.1 grams of cocaine as a topical, local anesthetic."

Use of alcohol was identified in 76.2% of the cocaine-related deaths. Some 81% of victims were smokers, and slightly more than half (52.3%) were obese.

Cardiovascular risk factors other than smoking and obesity were found in only 28.5%.

Nevertheless, cardiovascular causes of death were identified in 61.9%. Other causes of death included cerebrovascular disease (14.3%), excited delirium (14%), respiratory (5%), and metabolic (5%).

Coronary atherosclerosis was found 76.2% of the deaths and was severe in 28.6%. In six of the 16 men who had atherosclerosis, it was the main cause of death.

Lucena and his colleagues acknowledged that the study was limited by focusing on sudden deaths in cocaine users, which could result in a skewed look at the frequency of coronary artery disease among all cocaine users.

In addition, they wrote, the study cannot exclude the possibility that coronary disease is a consequence of combined effects of cocaine use and other cardiovascular risk factors.

The study was supported by the Thematic Networks Program of Cooperative Research: Characteristics of Sudden Death in Spain, Spanish Ministry of Health. Two of the study authors are supported by the Registry of Cardio-Cerebro-Vascular Pathology in Venice, Italy, and the CARIPARO Foundation in Padua, Italy.

Neither the study authors nor the editorialists reported any conflicts of interest.

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